EXTRAHEPATIC BILIARY
APPARATUS
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INTRAHEPATIC
BILIARY SYSTEM
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NOTOUR BUISNESS
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EXTRAHEPATIC BILIARY APPARATUSConsists of :
1. Rt. hepatic duct
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2. Lt. hepatic duct
3. Com. hepatic duct
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4. Cystic duct5. Com. Bile duct
6. Gallbladder
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HEPATIC DUCTS
? Emerge from
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porta hepatis
? Rt. & Lt. HDs
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unite to formCommon Hepatic
Duct(CHD)
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? CHD =4 cm
? CHD descend in
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lesser omentum? Joined by cystic
duct to form CBD
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GALL BLADDER
Pear shape
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?7-10 cm in length
?Up to 50 Ml
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?In the gallbladderfossa on the visceral
surface of the liver
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Gall Bladder(Parts)
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?Fundus?Body
?Neck
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?Infundibulum
(Hartmann's pouch)
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Surface projection of
fundus: Right linear
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semilunaris// right costalmargin = Murphy's point
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RELATIONS OFGALLBLADDER:
ANTERIORLY:
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? Ant. Abdominal wall
? Inferior surface of
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liverPOSTERIORLY:
? Transverse colon
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? 1st & 2nd
duodenum
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CYSTIC DUCT
? 3.8 cm
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? Somewhat S shaped? Its mucous membrane
is forming a spiral fold
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( the spiral valve )
CALOT'S TRIANGLE
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Moynihan's hump
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BLOOD SUPPLY:?ARTERIAL :
Cystic artery
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? VENOUS :
Cystic vein
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? LYMPHATICS :A cystic LN at the neck
of GB
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? NERVES :
Autonomic from
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coeliac plexusCholecystokinin
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BILE DUCT/COMMON BILE DUCT? 8cm(3 inch) long &
about 6mm in dia.
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? 1st course (Lesser
Omentum)
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? 2nd course(behind 2nd Duo.)
? 3rd course ( post.
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To head of
pancreas )
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Blood supply of Bile Duct
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SPHINCTERSClinical points:
? Gallstones
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? Biliary colic (epigastric pain, jaundice &pancreatitis)
? Acute cholecystitis & referred pain to
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shoulder
? Cholecystectomy ( variations )
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? Gangrenous ( single arterial supply )? Biliary atresia
Imaging of the Biliary Tract
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1. Cholecystography2. Ultrasound
3. Endoscopic Retrograde
Cholangiopancreatography(ERCP)
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4. Magnetic Resonance
Cholangiopancreatography(MRCP)
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Endoscopic retrograde
Magnetic resonance
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cholangiopancreatography(ERCP)cholangiopancreatography(MRCP)